Gender differentials and state variations in suicide deaths in India: the Global Burden of Disease Study 1990–2016

Abstract

SummaryBackgroundA systematic understanding of suicide mortality trends over time at the subnational level for India's 1·3 billion people, 18% of the global population, is not readily available. Thus, we aimed to report time trends of suicide deaths, and the heterogeneity in its distribution between the states of India from 1990 to 2016.MethodsAs part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016, we estimated suicide death rates (SDRs) for both sexes in each state of India from 1990 to 2016. We used various data sources for estimating cause-specific mortality in India. For suicide mortality in India before 2000, estimates were based largely on GBD covariates. For each state, we calculated the ratio of the observed SDR to the rate expected in geographies globally with similar GBD Socio-demographic Index in 2016 (ie, the observed-to-expected ratio); and assessed the age distribution of suicide deaths, and the men-to-women ratio of SDR over time. Finally, we assessed the probability for India and the states of reaching the Sustainable Development Goal (SDG) target of a one-third reduction in SDR from 2015 to 2030, using location-wise trends of the age-standardised SDR from 1990 to 2016. We calculated 95% uncertainty intervals (UIs) for the point estimates.FindingsThere were 230 314 (95% UI 194 058–250 260) suicide deaths in India in 2016. India's contribution to global suicide deaths increased from 25·3% in 1990 to 36·6% in 2016 among women, and from 18·7% to 24·3% among men. Age-standardised SDR among women in India reduced by 26·7% from 20·0 (95% UI 16·5–23·5) in 1990 to 14·7 (13·1–16·2) per 100 000 in 2016, but the age-standardised SDR among men was the same in 1990 (22·3 [95% UI 14·4–27·4] per 100 000) and 2016 (21·2 [14·6–23·6] per 100 000). SDR in women was 2·1 times higher in India than the global average in 2016, and the observed-to-expected ratio was 2·74, ranging from 0·45 to 4·54 between the states. SDR in men was 1·4 times higher in India than the global average in 2016, with an observed-to-expected ratio of 1·31, ranging from 0·40 to 2·42 between the states. There was a ten-fold variation between the states in the SDR for women and six-fold variation for men in 2016. The men-to-women ratio of SDR for India was 1·34 in 2016, ranging from 0·97 to 4·11 between the states. The highest age-specific SDRs among women in 2016 were for ages 15–29 years and 75 years or older, and among men for ages 75 years or older. Suicide was the leading cause of death in India in 2016 for those aged 15–39 years; 71·2% of the suicide deaths among women and 57·7% among men were in this age group. If the trends observed up to 2016 continue, the probability of India achieving the SDG SDR reduction target in 2030 is zero, and the majority of the states with 81·3% of India's population have less than 10% probability, three states have a probability of 10·3–15·0%, and six have a probability of 25·1–36·7%.InterpretationIndia's proportional contribution to global suicide deaths is high and increasing. ...

The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990–2017

“…[25][26][27][28] We found a positive, but modest, relationship between depressive disorders and suicide death rates at the state level, with suicide death rates also being higher in the southern states than in the northern ones. 21 This relationship has also been reported in previous studies. 29,30 It is also important to note that the high prevalence of depression among older adults has substantial implications because the population in India is ageing rapidly.…”

“…67,68 Importantly, the positive association of depressive disor ders and schizophrenia with suicide deaths, especially for females, needs urgent attention in primary care for suicide prevention, because Indian women have double the global suicide death rate. 21 Furthermore, telemedicine to provide mental health services in remote and inaccessible areas, internet-based and telephone-based helplines, and mental health mobile apps can reduce the burden on existing mental health services. [69][70][71] Communities and families have an important role in addressing mental health by reducing stigma and discrimination, raising awareness, and promoting inclusion.…”

“…The India State-Level Disease Burden Initiative has previously reported detailed trends of suicide deaths for all states of India. 21 The GBD 2017 methods relevant for this Article are summarised here and described in detail in the appendix (pp 3-39).…”

Suicide by pesticide poisoning in India: a review of pesticide regulations and their impact on suicide trends

“…Despite a moderate decline in suicide rate over the last 20 years, India still has a large burden of suicide [26]. In women, the rate of suicide is the fourth highest in the world, whilst in men it ranks 62nd [27], corresponding to around 230,000 deaths nationally in 2016.…”

Poisoning and its pattern among patients in a tertiary care center in Kancheepuram district, Tamil Nadu

“…[34] In India, an estimated 230,314 suicidal deaths occurred during 2016. [5] Poisoning is the second most common cause of suicide in India. The prevalence of pesticide poisoning is more in India, especially among farmers.…”