Suicide is the tragic and untimely loss of human life, all the more devastating and perplexing because it is a conscious volitional act.
India has the dubious distinction of having the highest number of suicides in the world. The National Crime Records Bureau (NCRB) reports that 1.71 lakh people died by suicide in 2022. The suicide rate has increased to 12.4 per 1,00,000 — the highest rate ever recorded in India. But these figures are underestimated due to an inadequate registration system, the lack of medical certification of death, stigma and other factors. Unfortunately, 41% of all suicides are by young people below the age of 30. Suicide is the leading cause of mortality for young women in India. A young Indian dies by suicide every eight minutes, which is a loss to family, society, the economy and future of the country. Suicide in the young is a major public health problem in India.
There is no single factor
Suicide is a complex human behaviour and it is futile to locate a single causative factor. Suicide in young people is best understood as multidetermined and the result of interaction between biological, psychological, familial, and social cultural factors.
A current review of adolescent suicides in India shows that the most commonly reported risk factors were mental health problems (54%), negative or traumatic family issues (36%), academic stress (23%), social and lifestyle factors (20%), violence (22%), economic distress (9.1%) and relationship factors (9%). Physical and sexual abuse, examination failure, intergenerational conflicts, parental pressures and caste discrimination are associated with youth suicide.
There are specific sociocultural factors for suicide among young girls and women. Arranged and early marriages, young motherhood, low social status, domestic violence and economic dependence are well documented. Rigid gender roles and discrimination have also been implicated. Failure in examinations drove 2,095 people to suicide in 2022. A system of education with an emphasis on scoring marks, and a one-point examination system, along with parental pressure and high expectation from oneself and the educational institutions contribute to suicides. Enormous competition to get into colleges, media hype around results, the shame associated with failure, and months of pent-up pressures and emotions result in a highly emotionally wrought state. Competitive examinations have also pushed many students to the edge. Tragically, even after obtaining a seat in prestigious professional colleges, academic pressure has led to many suicides.
Alcohol and substance use are known risk factors in youth suicides. The last two decades have witnessed a marked increase in Internet use among the young. A meta-analysis from 19 States of India revealed that almost 20% of college students are net addicts. One-third of young people are cyber-bullied. And of this sub-set, one third are suicidal. Teens who used social media for more than two hours a day are more suicidal.
The media has a strong influence on vulnerable young people. Sensational reporting of suicide, particularly by a celebrity, is followed by increased suicidal behaviour. Following the death of a very popular young male actor in India, there was a significant increase in searches on Google on “how to commit suicide”.
There are solutions
The view that suicides cannot be prevented is a commonly held one as people believe that it is an individual’s choice. Or it is because of socio-economic factors which are beyond their control. For an overwhelming majority of young people who engage in suicidal behaviour, there is often an alternate, appropriate resolution of their problems. Young people can be taught problem solving, impulse control and emotional regulation skills along with improving help-seeking behaviour. Early identification of mental distress and provision of care in a youth-friendly environment are essential. Adopting a healthy lifestyle (a good diet, regular physical activity, moderate and appropriate use of the Internet, cultivating supportive friendships, yoga and meditation) improves mental health and reduces suicide in the young.
Improving the family environment by reducing domestic violence and alcohol consumption, and providing economic assistance to the needy have been shown to reduce suicidal behaviour. Educational reforms such as alternative assessment methods and provisions to explore the potential of a young person are needed. Societal changes to reduce stigma and discrimination based on caste, religion and sexuality need to be addressed. Political will, intersectoral collaboration and commitment, and community participation are needed.
A strategy that needs more visibility
The Ministry of Health constituted a task force in November 2019 to develop a National Suicide Prevention Strategy for India. The final strategy was launched on November 21, 2022 with the objective of reducing suicide by 10% by 2030.
The strategy has recognised that collaboration between the Ministries of Health, Education, Information and Broadcasting, and Social Welfare is essential. The strategy focuses on the need to leverage educational institutions and youth organisations to promote mental health and reduce substance and behavioural addictions through school health ambassadors and youth clubs.
The immediate task is to disseminate the strategy to all States in India and stakeholders. Budgetary allocations are necessary and the strategies need to be implemented at the earliest at the State, district and community levels.
(Assistance for overcoming suicidal thoughts is available on the State’s health helpline 104, Tele-MANAS 14416 and Sneha’s suicide prevention helpline 044-24640050. Helplines across the country can be accessed here)
Dr. Lakshmi Vijayakumar is Founder, SNEHA, a suicide prevention centre, Head of the Department of Psychiatry, Voluntary Health Services (VHS) Chennai, Honorary Associate Professor, University of Melbourne and Member, World Health Organization Network on Suicide Prevention and Research
