Suicide Among Youth

Suicide is the third leading cause of death among young adults worldwide. There is a growing recognition that prevention strategies need to be tailored to the region-specific demographics of a country and to be implemented in a culturally-sensitive manner. This review explores the historical, epidemiological and demographic factors of suicide in India and examines the strategies aimed at the prevention of suicide. Suicide is among the top three causes of death among youth worldwide. According to the WHO, every year, almost one million people die from suicide and 20 times more people attempt suicide; a global mortality rate of 16 per 100,000, or one death every 40 seconds and one attempt every 3 seconds, on average. The suicide rate in India is comparable to that of Australia and the USA; and the increasing rates during recent decades is consistent with the global trend. Data on suicide in India are available from the National Crime Records Bureau (NCRB; Ministry of Home Affairs). The suicide rates in India rose from 6.3 per 100,000 in 1978 to 8.9 per 100,000 in 1990, an increase of 41.3% during the decade from 1980 to 1990, and a compound growth rate of 4.1% per year. Youth is a period of heightened risk of suicide and suicide is a leading cause of death among young people in India. In a study which evaluated the cause of death among those aged 10-19 years, in a rural population of 108,000 in south India, suicide accounted for about a quarter of all deaths in males and between 50% and 75% of all deaths in females aged 10-19 years.

 The average suicide rate for girls was 148 per 100,000, and for boys, 58 per 100,000. Among young people, suicidal behavior was found to be associated with female gender, not attending school or college, independent decision making, premarital sex, physical abuse at home, lifetime experience of sexual abuse, and probable common mental disorders.Violence and psychological distress were independently associated with suicidal behavior. Factors associated with gender disadvantage increased vulnerability, particularly in rural women. Suicide is an important, largely preventable public health problem. The problem is however a difficult one; as aptly expressed by Gajalakshmi et al as “a complex array of factors such as poverty, low literacy level, unemployment, family violence, breakdown of the joint family system, unfulfilled romantic ideals, inter-generational conflicts, loss of job or loved one, failure of crops, growing costs of cultivation, huge debt burden, unhappy marriages, harassment by in-laws and husbands, dowry disputes, depression, chronic physical illness, alcoholism/drug addiction, and easy access to means of suicide.” Since the greatest predictor of completed suicide is the presence of a previous suicide attempt, interventions aimed at suicide attempters may be the most effective in reducing suicide rates. Vijayakumar et al., 2011

 examined the efficacy of brief intervention and regular contact in a randomized controlled trial in suicide attempters and found that it did reduce rates of completed suicide over an 18-month period. Importantly however, the care received by the treatment-as-usual arm in this study was below desirable standards because it was limited to the acute management of the somatic sequelae of the suicide attempt and did not include psychiatric or psychological assessment or treatment.The task of suicide prevention is daunting. Although suicide attempters are at increased risk of completed suicide, about 10% of attempters persistently deny suicidal intent. This group may continue to be vulnerable. Though restricting availability of lethal means appears to be a possible solution, an early study in India in West Bengal, where legislation was introduced to restrict sale of a pesticide, found no reduction in the overall suicide rate, but merely a change in the modes of suicide. The solutions to suicide prevention may prove to be more complex than the problem of suicide itself.