Summary Background There are few epidemiological studies of suicide in India. Methods A nationally representative mortality survey determined the cause of death occurring in 1·1 million homes in 6671 small areas chosen randomly from all parts of India. Two trained physicians independently assigned codes to the causes of death, based on a nonmedical surveyor’s field interview with household respondents. Findings About 3% of deaths at ages 15 years and older (2684/95 335) were due to suicide. This corresponds to about 187 000 suicide deaths in India in 2010 at these ages (115 000 men and 72 000 women; age-standardised rates per 100 000 at ages 15 years and older of 26·3 for men and 17·5 for women). For suicide deaths at ages 15 years and older 40% percent of male suicides and 56% of female suicides occurred at ages 15–29 years. A 15 year old in India had an approximate cumulative risk of 1·3% of dying before age 80 years by suicide; men had higher risk (1·7%) than women (1·0%), with especially high risks in South India (3·5% among men and 1·8% among women). Suicide risks were higher in educated versus illiterate adults. About half of the suicides were from poisoning, much of which was pesticide. At ages 15–29 years, suicide accounted for nearly as many deaths as transport accidents in men and maternal deaths in women. Interpretation Suicide death rates in India are amongst the highest in the world. A large proportion of suicides occur at younger ages, especially in women. Much of Indian suicides may be avoidable, starting with control of access to pesticides. Funding U.S. National Institutes of Health

BackgroundIndia has long been thought to have more snakebites than any other country. However, inadequate hospital-based reporting has resulted in estimates of total annual snakebite mortality ranging widely from about 1,300 to 50,000. We calculated direct estimates of snakebite mortality from a national mortality survey.Methods and FindingsWe conducted a nationally representative study of 123,000 deaths from 6,671 randomly selected areas in 2001–03. Full-time, non-medical field workers interviewed living respondents about all deaths. The underlying causes were independently coded by two of 130 trained physicians. Discrepancies were resolved by anonymous reconciliation or, failing that, by adjudication.A total of 562 deaths (0.47% of total deaths) were assigned to snakebites. Snakebite deaths occurred mostly in rural areas (97%), were more common in males (59%) than females (41%), and peaked at ages 15–29 years (25%) and during the monsoon months of June to September. This proportion represents about 45,900 annual snakebite deaths nationally (99% CI 40,900 to 50,900) or an annual age-standardised rate of 4.1/100,000 (99% CI 3.6–4.5), with higher rates in rural areas (5.4/100,000; 99% CI 4.8–6.0), and with the highest state rate in Andhra Pradesh (6.2). Annual snakebite deaths were greatest in the states of Uttar Pradesh (8,700), Andhra Pradesh (5,200), and Bihar (4,500).ConclusionsSnakebite remains an underestimated cause of accidental death in modern India. Because a large proportion of global totals of snakebites arise from India, global snakebite totals might also be underestimated. Community education, appropriate training of medical staff and better distribution of antivenom, especially to the 13 states with the highest prevalence, could reduce snakebite deaths in India.

Bill & Melinda Gates Foundation and US National Institutes of Health.