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REVIEW ARTICLE www.indianjpsychiatry.org

Indian research on suicide

Lakshmi Vijayakumar
Sneha, Voluntary Health Services, 25/21 Ranjit Road, Kotturpuram, Chennai - 600 085, India

ABSTRACT

The suicide rate in India is 10.3. In the last three decades, the suicide rate has increased by 43% but the male female ratio
has been stable at 1.4 : 1. Majority (71%) of suicide in India are by persons below the age of 44 years which imposes
a huge social, emotional and economic burden. Fifty four articles on suicides have been published in IJP. Several
studies reveal that suicidal behaviours are much more prevalent than what is officially reported. Poisoning, hanging
and self immolation (particularly women) were the methods to commit suicide. Physical and mental illness, disturbed
interpersonal relationships and economic difficulties were the major reasons for suicide. The vulnerable population was
found to be women, students, farmers etc. A social and public health response in addition to a mental health response is
crucial to prevent suicidal behaviour in India.

Key words: Suicide, India, Risk factors

INTRODUCTION by persons below the age of 44 years imposes a huge social,

emotional and economic burden on society.
More than one lakh lives are lost every year due to suicide in
India. In the last three decades (from 1975 to 2005), the suicide The near equal suicide rates of young men and women
rate increased by 43%. The rates were approximately the same and consistently narrow male:female ratio denotes that
in 1975 and 1985; from 1985 to 1995 there was an increase more Indian women die by suicide than their Western
of 35% and from 1995 to 2005, the increase was 5%. However, counterparts. Poisoning (34.8%), hanging (31.7%) and self-
the male-female ratio has been stable at around 1.4 to 1. There immolation (8.5%) were the common methods used to
is a wide variation in suicide rates within the country. The commit suicide (accidental deaths and suicide 2007).[2] Two
southern states of Kerala, Karnataka, Andhra Pradesh and
large epidemiological verbal autopsy studies in rural Tamil
Tamil Nadu have a suicide rate of .15 while in the Northern
Nadu reveal that the annual suicide rate is six to nine times
States of Punjab, Uttar Pradesh, Bihar and Jammu and Kashmir,
the official rates. If these figures are extrapolated it suggests
the suicide rate is ,3. This variable pattern has been stable for
that there are at least half a million suicides in India every
the last 20 years. Higher literacy, a better reporting system,
lower external aggression, higher socioeconomic status and year. It is estimated that one in 60 persons are affected by
higher expectations are the possible explanations for the suicide. It includes both, those who have attempted suicide
higher suicide rates in the southern states (Vijayakumar L, and those who have been affected by the suicide of a close
2008).[1] family or friend. Thus, suicide is a major public and mental
health problem which demands urgent action.
Majority of the suicides (37.8%) in India are by those below
the age of 30 years. The fact that 71% of suicides in India are Fifty four articles on “Suicide” have been published in the
IJP from 1958 to 2009. The relative paucity in publications
Address for correspondence: Dr. Lakshmi Vijayakumar, can be attributed to several factors but chiefly to the fact
25/21 Ranjit Road, Kotturpuram, Chennai - 600 085, India. that it is an extremely difficult area to take up for research
E-mail: dr_svk@vsnl.com considering its sensitive nature, associated stigma and legal
DOI: ***** implications. It is interesting to note that the first article
on attempted suicide appeared only in 1965. The articles
ranged from references to suicide in ancient literature to
How to cite this article: Vijayakumar L. Indian research on
psychobiological variables in suicide, epidemiological
suicide I. Indian J Psychiatry 2010;52:S291-6.
studies to prevention strategies.

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The publications have been categorized under (1) Incidence These findings were supported by Banarjee et al.[7] who
and prevalence studies (2) Profiling and identification of studied the vulnerability of Indian women. They found
risk factors (3) Suicide and suicidal behavior in specific that the incidence of suicide was 43/100,000 in Bengal and
communities (4)Studies on Non Fatal Deliberate Self Harm that women (79.3%) outnumbered men. 75% of the victims
(DSH) (5) Suicide prevention strategies (6) and other, were below 25 years of age and the commonest cause for
suicide related publications. The segregation is for the suicide in women was quarrel with husband, while in men
sake of convenience alone and should not be seen as being it was with parents. Ingestion of insecticide was the most
exclusive to its allocated category. common method of committing suicide.

There have been four studies from abroad published in the PROFILING AND IDENTIFICATION OF RISK
IJP that have not been covered in the present review, these FACTORS
comprise of a study on women from Trinidad and Tobago,
a study from US on adolescence, on teenage suicide Majority of the published studies on suicide have dealt with
attempters from UK and a Japanese study on pesticide identifying the socio-demographic and psychosocial aspects
suicides. of suicide attempters and those who have completed
suicide. Some of these have also attempted to identify the
INCIDENCE AND PREVALENCE STUDIES characteristic differences between the two groups. Most of
these were hospital based studies. The study methods used
There have been several studies reporting the incidence of varied, from use of psychological autopsies to interviews to
suicide in India. Over the years the studies have reported perusal of records.
incidence rates ranging from 2.36 to 42 per 100,000
populations. The majority of these have been hospital Venkoba Rao[3] in his hospital based study on suicide
based studies along with a few community based samples. attempts reported a preponderance of males and identified
the vulnerable age group as being those from 15 to 25 years.
Lack of social cohesion was identified as a significant risk
In one of the first article on attempted suicide published
factor. 20% of the attempters also had a family history of
by the IJP, Venkoba Rao[3] reported an incidence rate of
mental illness/suicidal attempts. The method of attempting
43 / 100,000 in Madurai. He also reported that 1 in 12 cases
suicide as well as the time (during daytime or night), were
of suicide attempts were fatal.
not seen as factors influencing intent.
Nandi et al.[4] studied incidence rates in Bengal using data
In another hospital based study Lal and Sethi[8] reported
available in the public domain across a hundred year period
that women attempted suicide more often, were below
(1872-1972) and reported that the incidence of suicide
30 years of age, were housewives or domestic help, married
had increased significantly from 2.36/100,00 in 1872 to
and income levels of 83.4% was less or equal to Rs. 200
15.96 in 1972. The study also revealed that there was per month. Females with lower educational level and joint
preponderance of male suicides, the vulnerable age group families and males with higher educational levels and
being those between the ages of 18 to 30 and the most from unitary families attempted suicide more frequently.
common method employed was poisoning. Similarly, a study by Badrinarayana[9] also revealed that
younger people (age range of 10 to 30 years) were more
Hedge[5] in his study on the patterns of suicide in a rural likely to attempt suicide. The primary causes were identified
community in northern Karnataka reported an incidence as Mental illness and disturbed interpersonal relationships.
rate of 9.3/100,000. The study also reported a male (67%) Extramarital affair was also identified as a risk factor for a
preponderance. The study also revealed that rural suicide spouse to attempt suicide by Venkoba Rao.[10]
patterns did not vary from urban.
Nandi et al.[11] investigated the relationship between
In contrast to these reports Shukla et al.[6] in their study availability of lethal insecticide and the incidence of suicide.
on the incidence of suicides in Jhansi city reported The study concluded that there was no association between
more suicides among women (34 / 100,000) than men the easy availability of the lethal insecticide and the high
(24 / 100,000). Several other gender related differences incidence of suicide but rather it was the motive which
were also reported, women were significantly younger actually determines the incidence of suicides.
(24.6 years) compared to the men (28.9 years), self
immolation was the most frequent method of suicide by Bagadia et al.[12] attempted to examine the relationship
women while for men it was being run over by a train. between unemployment and suicide and concluded that
Domestic strife and mental illness were identified as the though unemployment may be an important factor in suicide
most common causative factors. The study reported an it did not appear to be the causative factor. The study
incidence rate of 29/100,000. postulated that both unemployment and suicidal behavior

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could be due to some common psychopathological factors. In his comparison study between suicide attempters and
However, Srivatsava et al.[13] (2004) identified unemployment, completers, Suresh Kumar,[24] reported that those who
presence of a stressful life event in the last six months, completed suicide were significantly younger, they were
suffering from physical disorders and having idiopathic pain more frequently unemployed and used more lethal methods
as definite risk factors for attempting suicide. (hanging) than those who attempted. Other variables such
as religion, domicile, marital status and education showed
In their study from Ludhiana, Narang et al.[14] reported no difference.
that single males and married females were more likely to
attempt suicide. They, however, did not find type of family, Very few studies pertaining to the biology of suicides have
economic status and educational levels as being significant been published in the IJP. The earliest article published was
variables. Mood disorders and adjustment disorders were by Devi and Rao,[25] who studied the association between
diagnosed in a significant number of them. suicide attempts and menstrual cycles. The study reported
that women in their pre-menstrual/early menstrual phase
Bagadia et al.[15] conducted a study on 521 patients admitted (64%) were more vulnerable. Marital status of the patients
for suicidal behavior and reported that the degree of intent did not contribute to any heightened vulnerability during
was low, duration of suicidal ideas ranged from more than premenstruum and menstruation.
1 year (2%) to it being an impulsive act in 17% of them, 18%
communicated about the attempt while the majority of Palaniappan, et al.[26] explored the possible association
women (76.1%) attempted suicide in the presence/proximity between suicidal ideation and biogenic amines. They
of others. Previous attempts were reported in 7% with observed that the levels of 5 HIAA and Serotonin (5HT) were
2.4% having more than one previous attempt. Depression inversely related to suicidal ideas. Rao and Devi[27] in their
(39.73%), schizophrenia (24.4%) and hysteria (14%) were the article state that evidence from genetic research, mono
most common psychiatric diagnosis made. amine studies and psychopharmacological research points
towards a possible biological predisposition and precipitant
These findings were also confirmed by Gupta and Singh[16] for suicidal behavior.
who reported psychiatric disorders in 62% with 58%
having abnormal personalities. Mahla, et al.[17] investigated SUICIDE AND SUICIDAL BEHAVIOR IN SPECIFIC
attempted cases of self immolation and reported that the COMMUNITIES
behavior was associated with the presence of psychiatric
and personality disorders. Jain, et al.[18] also found that 37.5% There have been several studies which focus on vulnerable
of the suicide attempters had a diagnosis of depression, populations and high risk populations including students,
39.28% of the subjects showed mild to moderated the aged, women, armed forces, farmers, migrant
suicidal intent and 16% of them had a high score on the populations and those with chronic physical and mental
hopelessness variable. Similarly, in their study using the illness.
method of psychological autopsy, Khan, et al.[19] identified
the presence of psychiatric illness and stressful life events Venkoba Rao,[28] in his article on attempted suicide
as the two most important reasons for completing suicide. among students, reported that during a 10-month period
35 students had attempted suicide, of which seven proved
Badrinarayana[20] found a positive and significant correlation fatal. The most common mode was insecticide ingestion.
between depressive illness, suicidal ideation with early There were more male students (19) than female (16), most
parental deprivation, recent bereavement and positive family were aged between the ages of 16 to 30 and majority of
history of suicide. Similarly Srivastava and Kulshreshtha[21] them were students of Arts and Sciences. Eight of them had
reported a positive correlation between severity of attempted suicide previously. No intellectual sub-normality
depression, being married, being employed, being male, was reported in the sample.
prior history of treatment in a mental hospital setting, more
than a month’s duration of illness and age being less than or In an another study on the psychosocial and clinical factors
equal to 35 years. associated with adolescent suicidal attempts Kumar,
Sudhir et al.[29] compared potential risk factors between
Anand, et al.[22] in their study on suicidal intent identified adolescent and adult suicide attempters and found
three distinct groups comprising of non communicators that the adolescents had significantly higher levels of
(31.9%), partial communicators (32.6%) and definite depression, hopelessness, lethality of event, and stressful
communicators (35.5%). A study by Ponnudurai et al.[23] life events. Sharma, et al.[30] in their study on adolescent
revealed that 23.25% had contemplated suicide earlier and students found the prevalence of suicide risk behavior
that 91.9% of them were aged 30 years or less. A strong quite high with almost 16% having suicide ideation and
association with alcohol was reported in 10.42% of the 5% having attempted suicide. Females were seen as being
sample. more vulnerable. The presence of role models who were

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seen drinking and smoking was seen as increasing the risk student. Suicide attempters also had more suicidal ideation,
behavior. agitation and paranoid symptoms.

Rao Venkoba,[31] studied depression and suicidal behavior In a study on the armed forces Goel[38] argued that suicidal
in the aged and reported that the risk of completed suicide attempts do not constitute a major health concern in
among the aged attempters is twice that of the younger the army and that being in the army does not make the
generation. He also identified lack of social integration individual more vulnerable than the general population
rather than social isolation per se as the factor causing to suicide. Chakraborthy[39] in his study reported that the
depression in the aged. age of suicide attempters in the Army in India was higher
than those reported from western countries. Isolation and
In a study on 100 female burns cases admitted at the inability to form relationships were identified as important
Madurai Medical college Venkoba Rao, et al.[32] reported factors in the suicidal attempts.
that that 70% of them were suicidal attempts, 25% were
accidental, 3% were homicidal and 2% were non classifiable. The need to focus on migrants as a specifically vulnerable
The most common reasons for suicidal attempts were group was brought out by the study of Chavan, et al.[40] who
marital and interpersonal problems followed by psychiatric used psychological autopsies to reveal that almost 58%
and physical illnesses respectively. were migrants from other parts of India, were frequently
male and young (age 20 to 28 years). Hanging was the
Jacob, et al.[33] in their comparative study on subjects with most commonly used method for committing suicide.
seizure disorder and bronchial asthma found that 34% of Psychosocial stressors were found in 61% and psychiatric
the epilepsy group had a diagnosis of major depressive illness was found in 34%. Only 16% had sought treatment
disorder as compared to 13.3% of the asthma group. Sixteen prior to their attempt
per cent of the epilepsy group had a history of at least one
suicidal attempt in the previous year and 20% of the group On a study on farmer suicides in the Vidarbha region, Behere
expressed current suicidal ideation. and Behere[41] employed the psychological autopsy method
to understand the phenomenon and have identified the
In a study on terminally ill cancer patients Latha and Bhat[34] following reasons for farmer suicide (1) chronic indebtedness
examined the prevalence of suicidal ideation and reported and inability to pay debts accumulated over the years
that only 9.2 % had severe suicidal ideations. 3.8% of the (2) economic decline that leads to complications, family
patients with suicidal ideation had a past history of major disputes, depression, alcoholism, etc. (3) compensation
depression. Factors such as presence of pain, awareness following suicide helps the family repay debts (4) grain
of diagnosis, and understanding of the illness contributed drain and (5) rising costs of agricultural inputs and falling
to the depressive states. The study concluded that suicidal prices of agricultural produce.
ideation and desire for death appeared to be linked
exclusively to the presence of a psychiatric disorder. STUDIES ON NON FATAL DELIBERATE SELF
HARM
Satyavati[35] investigated attempted suicides in psychiatric
in patients and reported that during a one year period Sethi, et al.[42] studied 75 patients admitted for self
out of 1881 admissions 126 had made suicidal attempts destructive behavior and found that majority of them
with drowning being the most commonly employed belonged to unitary family set up, were unmarried males
method. Patients with schizophrenia accounted for 64% and almost 15% of them had history of previous suicidal
of the attempted suicides. Gupta, et al.[36] in their two-year attempts. Financial stress, rejection in love and strained
follow-up study of patients who had attempted suicide familial relationships were the most common causes.
with schizophrenia and depression reported that 51.8%
of the suicide attempters had a personality disorder, 42% Sarkar et al.[43] attempted to present a profile of those who
had neurotic symptoms during childhood and 23.5% had a commit DSH in comparison with those who expected to
history of drug dependence. During the follow-up period die after the suicide attempt. Those attempting DSH were
17.1% of the schizophrenia patients had attempted suicide younger, chose less lethal methods to attempt suicide,
again with one completing suicide, compared to 19% of the were more impulsive and had strong histrionic and unstable
depressed patients. traits in personality and had an absence of a family history
of suicide attempts.
Srivastava and Kumar[37] in their study on patients with
major depressive disorder reported that the 17% in patients Das, et al.[44] in their study on subjects with intentional
with suicidal ideation attempted suicide, The risk factors self harm attempts reported that the majority of the
identified were being below 30 years of age, having higher subjects were married, educated beyond matriculation,
education, being a single male or a married woman or a were employed or retired, belonged to a nuclear family,

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were of a middle socio economic status, and came from for suicide prevention in India and stresses that suicide
an urban background. The most common reasons for the is a multifaceted problem and hence suicide prevention
attempt were interpersonal problems with family members programs should also be multidimensional. Collaboration,
and spouse. The most common mode was consumption coordination, cooperation and commitment are needed
of insecticides followed by use of corrosives. The most to develop and implement a national plan, which is cost-
common psychiatric diagnosis in the group was depression. effective, appropriate and relevant to the needs of the
The use of organophosphorous pesticide poisoning for DSH community. In India, suicide prevention is more of a social
was also reported by Chowdhury et al.[45] who found it the and public health objective than a traditional exercise in the
most commonly used method. mental health sector. She concludes by saying that the time
is ripe for mental health professionals to adopt proactive
In their study on non fatal deliberate self harm attempters, and leadership roles in suicide prevention and save the lives
Chowdhury et al.[46] identified women exposed to domestic of thousands of young Indians.
violence as a vulnerable group. They were generally below
30 years of age, married and with low education, Pesticide OTHER SUICIDE RELATED PUBLICATIONS
poisoning was the commonest mode of DSH attempt.
Marital conflicts, conflicts with in-laws were the typical Gupta, et al.[51] published an article on the development of a
stressors. Majority of them experienced more than one form 10 item suicidal intent questionnaire. The article established
of domestic violence. The study concluded that stressful that the questionnaire was fairly valid but stated that further
life situations along with easy availability of pesticides work was necessary to establish its statistical validity and
facilitated self harm behavior. reliability.

SUICIDE PREVENTION STRATEGIES Somasundaram et al.[52] in their paper described the

presence of suicide behavior as found in ‘Purananuru’ an
There have been very few articles that have dealt exclusively ancient Tamil classic from the ‘Sangham’ period. The article
with suicide preventive strategies or with a scientific and documents the self immolation of Perun Koppendu on
systematic evaluation of a strategy. the death of her husband, the fast unto death of a Cheran
king in response to being insulted by guards and suicides
Singh[47] in his article evaluated the various suicide of important kings and poets because of bereavement.
prevention activities such as the community activities, The influence of religion and other cultural beliefs and its
the psychiatric and medical activities, suicide prevention influence on perceptions of suicide and its representation
centers, psychiatric emergency services, crises intervention in popular culture with specific referenced Tamil literary
centers, role of general practitioners, research and media. classics has been brought out in this article.
He concluded by stressing on the role of the psychiatrist in
dealing with this issue. CONCLUSION

Venkoba Rao[48] in his article delineated the risk factors A social and public health response to suicide is crucial in
associated with suicidal attempts and its association with India, and should complement a mental health response.
psychiatric disorders and the biological evidence for suicidal Mental illness is a risk factor for suicide, in India, as it is in
behavior. The article based on cited studies recommended developed countries. However, additional risk factors are
that education of general physicians, limiting access to prominent in India. These tend to relate to societal structures
availability of antidepressants, paracetemol and pesticides and specific stressors. A social and public health approach
would lower the rates of suicide. acknowledges that suicide is preventable, and promotes
a framework in integrated system of interventions across
Jena and Siddharta[49] reviewed articles on non fatal suicidal multiple levels within society including the individual, the
attempts of adolescents in both Indian and international family, the community, and the health care system. A key
literature. They stated that non fatal suicidal behavior among step in such an approach involves modifying attitudes
adolescents needs to be evaluated and managed effectively toward suicide via educational efforts and legal levers (e.g.
in order to reduce the rates. They concluded that Indian decriminalizing suicide).
studies in this area are a very few and there is a great need
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Source of Support: Nil, Conflict of Interest: None declared
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