The Scary Numbers of Suicides in India - Time to Really Care
An ASAR Data Story
By ASAR Blog Team
Ideation & Drafting
Divya Shrinivas, Parth Sharma, Siddhesh Zadey
Calculations & Visualisations
Parth Sharma, Pratik Gavhane, Jatin Terde
Pratik Gavhane, Jatin Terde, Divya Shrinivas, Parth Sharma
Review & Editing
Parth Sharma, Siddhesh Zadey
“Soak up the views. Take in the bad weather and the good weather. You are not the storm”
Trigger Warning: This article talks about data related to self-harm and suicide. If suicide is a trigger, this article may not be for you. Please skip to the end of the article if you are looking for resources to get help.
What is the one news article you are bound to come across more often than the others, irrespective of whichever corner of the world you live in? The answer, not very difficult to predict, is suicide. According to the World Health Organization (WHO), one person dies every 40 seconds from suicide worldwide. It is the fourth leading cause of death among young people aged 15-29 years. 77% of global suicides occur in low- and middle-income countries. India and China, two of the most rapidly growing labor-abundant economies account for 49% of all suicides.
The WHO estimates that of the nearly 900,000 people who die from suicide globally every year, nearly 170,000 are from India. According to the National Mental Health Survey of 2015-16, 9 per 1000 people were at a high risk of suicide in India, which means that they had either thought of or attempted suicide at least once in that year.
Suicide prevention is important for countries to achieve global health standards. Sustainable Development Goals (SDGs) use the suicide death rate as an indicator under Target 3.4. September 10 is celebrated as World Suicide Prevention Day every year. Keeping in mind this year’s theme, ‘Creating Hope through Action’, in this ASAR Data Story, we aim to look at the various facets associated with deaths due to suicides so as to highlight the magnitude of this rampant public health concern using publicly available data from various government and epidemiological resources.
1. How does the suicide death rate in India compare to the rest of the world?
India reports one of the largest numbers of deaths due to suicide, with more than 1,20,000 deaths, every year. These high numbers are worrisome even with India’s huge population. According to the Global Burden of Disease study 2019, India ranks 158 out of 204 countries in terms of the suicide death rate, i.e., the number of deaths due to suicide per 1 lakh population (Fig 1). In 2019, WHO estimated that nearly 1 out of every 4 global suicide deaths happened in India.
2. How are Indian suicide death rates reported across different sources - NCRB, MCCD, and GBD?
The National Crime Records Bureau (NCRB), is an Indian government agency responsible for collecting and analyzing crime data. To publish its report on suicides in India, the NCRB collects and validates data from local police and central law enforcement agencies.
Under the system of Registration of Births & Deaths, the scheme of Medical Certification of Cause of Death (MCCD) is an integral part of the Vital Statistics System. It generates a database for total deaths in India through verbal autopsies (possible causes of death as told by the family member during surveys).
Contrary to the above two sources that report ‘actual’ data, the Global Burden of Disease (GBD) Study estimates the numbers using multiple resources: vital registration, verbal autopsy, police records, community surveys, research papers, and mortuary/hospital data. Using these resources, GBD researchers generate multiple models and finally, using the most accurate model, report the closest estimate after adjusting for all possible reporting biases.
By comparing these three sources of data that report deaths due to suicide in India, we aim to understand the extent of differences across sources. As the most recent GBD estimates are available for 2019, we compare suicide deaths reported by NCRB, MCCD, and GBD in 2019.
The GBD study estimated India’s suicide death rate to be 13.8 deaths per 1 lakh people as opposed to that of 10.4 reported by NCRB in 2019. Compared to GBD, the average under-recording in NCRB among males was 27% (range 21%-31%) per year and 50% (range 47%-54%) per year among females. GBD estimated a higher suicide death rate in 17 Indian states (Fig 2a).
In 2019, suicide or intentional self-harm deaths reported by MCCD were only 3.7% of those recorded under NCRB. As the medical cause of death was certified only in 22.5% of the deaths in India, it is possible that suicide as the cause of death was missed out in nearly 3 out of 4 deaths. We, therefore, projected the possible suicide numbers in MCCD by adjusting the raw numbers with the state-wise proportion of registered deaths that have certified medical causes. However, the numbers, after adjustment, are still lower as compared to the NCRB report. Except for 4 states, all the other Indian states had higher suicide death rates reported by NCRB as compared to MCCD in 2019 (Fig 2b).
Even though the reliability of the available data is questionable, it helps us in monitoring the patterns and trends of suicide-related deaths in the country.
3. How has the suicide death rate in India changed over the years for males and females?
The NCRB reported a total of 1,64,033 deaths due to suicides in 2021, showing an increase of 7.2% from 2020. The suicide death rate in India was reported to be 12, which means that 12 out of every 1 lakh Indians died by suicide in 2021 (Fig 3).
The suicide death rate has increased for males by nearly 4 deaths per 1 lakh males in the last 6 years (17 deaths per 1 lakh males in 2021 vs. 13.4 deaths in 2016) (Fig 3). However, for females, the suicide death rate has been hovering at less than 7 deaths per 1 lakh females over the same 6-year period. Similar to global numbers, in 2021, the number of suicide deaths in males was nearly thrice that in females (118,979 male deaths vs. 45,026 female deaths).
4. What are the common reasons for suicide deaths in males and females?
‘Family problems’ was the leading reason for suicide-related deaths in both males and females in India in 2021. While males were found more likely to commit suicide because of illnesses, bankruptcy, and alcohol or drug abuse, the common reasons in females for committing suicide were found to be illnesses, marital issues, and love affairs. Interestingly, almost 3 times more females committed suicide owing to marital issues than males in 2021 (Fig 4).
5. Suicides in people identifying as transgender - How serious is the problem and what are the common causes?
Considering the high rates of severe depression and suicidal tendencies among Indian gender minorities, suicides in transgender people seem to be under-recorded under NCRB. Over the past six years (2016-2021), only 110 suicides have been recorded among transgender people. Collectively, over the past 6 years, illness (30%) and family problems (19%) were the top two reported reasons for suicides followed by substance abuse (9%) and unemployment (5%) (Fig 5).
https://datawrapper.dwcdn.net/ykmxx/2/ 6. Which age group in India has been affected the most by suicide deaths over the last 6 years?
According to NCRB, every year, the highest number of lives are lost to suicide in the age group of 18-30 years in India. One in three people who die due to suicide belongs to this age group. While each age group’s contribution to suicide death rates has been almost static over the years, a slight increase in the number of suicide deaths among people older than 60 years has been noticed over the past 6 years (Fig 6).
7. What are the commonly reported reasons for suicides across age groups?
Family problems followed by illnesses were reported to be the most common reasons for suicide in people less than 60 years of age. For people older than 60 years, illnesses formed the most common reason for suicide, followed by family problems. For all age groups, drug or alcohol abuse was the next most common reason for suicides in India. In people, less than 18 years of age, failure in the examination was reported 9% of the time as the reason. The age group of 18-30 years reported the most deaths due to love affairs and unemployment as compared to the other age groups. The reason for suicide, however, was not reported for nearly 10% of all suicide deaths (Fig 7).
8. How were suicide deaths distributed across states in 2021?
About a third of 1.6 lakh suicide deaths, were reported from just 3 states: Maharashtra, Tamil Nadu, and Madhya Pradesh. Nagaland with 43 deaths reported the lowest suicide-related deaths in the country. Andaman and Nicobar Islands, Sikkim, and Chhattisgarh reported more than 30 deaths per 1 lakh people. Whereas, Bihar, Manipur, Uttar Pradesh, and Nagaland reported less than 2 deaths per 1 lakh people (Fig 8). Twenty states/union territories (UTs) saw a rise in suicide death rate in 2021 compared to 2020 with Telangana recording the highest rise of 26%. Of the 15 states/UTs that saw a drop in suicide death rate in 2021, Lakshwadeep recorded a drop of 50% in its suicide death rate followed by a drop of 24% in Uttarakhand.
However, independent researchers have found that Indian states like Bihar and Uttar Pradesh with low socio-demographic index (SDI), a metric used to measure social and economic development, had a higher under-reporting in NCRB data compared with states with higher SDI values such as Sikkim and Delhi.
9. What were the educational backgrounds of the people who died due to suicide in 2021?
In 2021, a rising trend in suicide-related deaths was noticed with the rising level of education of the victims, from lack of education to 10th standard (Fig 9). However, a drop in deaths due to suicide was noticed at educational attainment higher than the 10th standard which could be explained by a smaller population of people with that level of education in India. This pattern was noticed to be similar across males and females.
10. Does household financial background play a role in suicides in India? In 2021, the maximum number of suicides in India occurred in households with an annual income of less than 1 lakh rupees (Fig 10). The number of deaths due to suicide decreased progressively as one climbed up the financial ladder with the least number of suicides being reported in households with an annual income of more than 10 lakh rupees.
11. Does the number of suicides differ by professional background among males and females in India?
In 2021, out of the total 45,026 females who committed suicide, over 50% were housewives followed by students and daily wage earners. This is in line with the trend in the past five years, where suicides in housewives have made up more than 50% of the total female suicides. Compared to this, out of the nearly 1.2 lakh male suicides, the maximum number of suicides deaths were among daily wage earners, followed by self-employed and unemployed men. The least number of suicides were reported in retired persons who form 0.9% of the total suicides (Fig 11).
Note: In the following questions we look at ecological relationships, i.e., those between state-level aggregate numbers, like SDG scores and greater unemployment rates to suicide death rates. The results, however, in certain situations, are contrary to the expectations. This could be a result of ecological bias. As the data looks at the state’s population as a whole and not the individuals in the state, it is possible that factors affecting certain parts of the community with high (or low) suicide rates might have been missed. For example, if a state has a low unemployment rate but had higher suicides in the unemployed section of the population in the state, on comparing the suicide rate and unemployment rate for that particular state it might look like low unemployment rates lead to more suicides which might not be true.
12. Is unemployment related to suicides in India?
The greater unemployment rate (GUER) is defined as the number of unemployed people willing to work, whether or not they are actively looking for a job, expressed as a percentage of the greater labor force, which includes the labor force and the unemployed people not actively looking for a job. We found that states with lesser GUER had higher suicidal death rates (Fig 12).
13. Are SDG scores related to suicide death rates for Indian states?
Sustainable Development Goals (SDGs) are a collection of 17 interlinked global goals. These are taken up by countries to improve the quality of human lives while protecting the environment. They were set up in the year 2015 by the United Nations General Assembly and are intended to be achieved by 2030.
The suicide mortality rate is an indicator under Target 3.4 of the SDGs. Under this target, the aim is to reduce early deaths due to suicides by one-third and promote the mental health and well-being of the people. Here we look at four SDG scores (1,4,5, and 8), assessed in 2021, and try to understand their impact on suicide death rates in India.
13a. Is poverty (SDG 1) related to suicide death rates across states in India?
SDG 1 calls for an end to poverty in all its manifestations by 2030. A higher score depicts lesser poverty in the state. We saw that states with a lower score (higher poverty), have lower suicide death rates while those with higher scores have greater suicide death rates (Fig 13a). A plausible explanation for this could be the underreporting of suicides in some states that also rank low on the socio-developmental index.
13b. Is the quality of education (SDG 4) related to suicide death rates across states in India?
SDG 4 score accesses inclusiveness, accessibility, affordability, and quality of education and a higher SDG 4 score correlates with better education in the state, based on the above parameters. As previously noticed, a higher level of education was noticed to be associated with higher suicide death rates, which could also be a contributing factor here. Also, states with high SDG 4 scores like Kerala and Tamil Nadu reported higher rates of suicides, which could be attributed to higher literacy and thus better reporting. (Fig 13b).
13c. Is gender inequality (SDG 5) related to suicide death rates across states in India?
SDG 5 looks at gender equality and empowerment of all females. A higher SDG 5 score means more gender equality in the state. States with a higher SDG 5 score like Kerala, Andhra Pradesh, and Karnataka had a male-to-female suicide ratio closer to 3:1 while states with a lower SDG 5 score like Bihar, Uttar Pradesh, and West Bengal had a male-to-female suicide ratio closer to 1:1 (Fig 13c). This result is similar to that of a global study that found that the male-to-female suicide death ratio was higher in countries with more equitable gender norms and vice versa.
13d. Is economic growth (SDG 8) related to suicide death rates across states in India?
SDG 8 looks at sustained, inclusive, and sustainable economic growth, full and productive employment, and decent work for all. A higher SDG 8 score points toward better economic growth in the state. Contrary to expectation, we noticed states with better economic growth had a higher suicide death rate in 2021 (Fig 13d).
14. What are the common signs and symptoms a person with high suicidal risk shows and how can one seek help?
Even though suicides can be unpredictable, there are some signs that we can look out for in our friends and family. According to the National Institute of Mental Health (USA), the following signs should raise the suspicion of high suicidal risk:
When a person talks about wanting to die, guilt or shame, or being a burden to others.
When a person feels empty, hopeless, trapped, or feels he/she has no reason to live.
When a person makes a plan or researches ways to die.
When a person withdraws from friends.
When a person starts taking dangerous risks such as driving extremely fast.
When a person displays extreme mood swings.
When a person eats or sleeps more or less as compared to usual.
When a person uses drugs or alcohol more often than usual.
In case you or anyone around you is showing any of these or other warning signs, these are some of the sources to get help from:
As we witness in this ASAR Data Story, suicide is a multi-dimensional issue. Meaningful interventions are those that can act on biological, psychological, and social aspects of this problem. The pandemic has led to an increase in mental health illnesses. Rising mental health illnesses have led to an increase in intentional self-harm worldwide. With India carrying a huge burden of both mental illnesses and suicide deaths, addressing these issues has now become a public health emergency.
While the recent decriminalization of suicide is expected to improve community-level reporting of suicides, suicide prevention policies should be developed, with a priority to address the social stigma attached to suicide and suicidal behavior. We need to change the approach. The recent ban on rat poison in Tamil Nadu only addresses the mode of suicide. If this move alone will help in controlling suicides in Tamil Nadu is doubtful. Rather than addressing the modes of suicide, the focus should be shifted to addressing the reasons for suicides. Using a multi-faceted approach, India needs to urgently tackle its high burden of suicide deaths in order to not fail the most vulnerable people.
How to cite this article: Shrinivas D, Sharma P, Gavhane P, Terde J, Zadey S. The Scary Numbers of Suicides in India - Time to Really Care [Internet]. Association for Socially Applicable Research (ASAR). 2022. Available from: https://www.asarforindia.org/post/the-scary-numbers-of-suicides-in-india-time-to-really-care