Suicide is our problem too

In recent years, suicides have risen as a major public health problem contributing to significant number of deaths, hospitalization and socioeconomic losses in India. Suicides, attempted suicides and suicidal ideations/ behaviors are commonly seen in every part of India, even as the numbers vary in different places.

Some studies reveal that for every person who dies from suicide, at least ten to fifteen more have attempted suicide, while a hundred more have thought about it. Since we as a population do not pay serious attention to such thoughts and behaviours, it largely goes unnoticed and undetected, leaving several others vulnerable to attempt or die by suicide. This places the onus of preventing suicides not only with the medical fraternity and the government, but also with society. Provided we are equipped with the skills to identify persons with suicidal thoughts around us.

In this section on suicide prevention, we will help you understand what you can do help prevent suicides which are a public health issue.

But before that, let us understand the magnitude of the problem that is lying amongst us. As per official reports from National Crime Records Bureau (NCRB), Ministry of Home Affairs, Government of India, 1, 34,799 persons lost their lives in suicidal act during the year 2013. Suicides have seen a phenomenal increase over time in India from nearly 40,000 in 1980 to 135,000 by 2013. The national rate of suicides is 11/100,000 population per year.

Independent research studies by World Health Organization (WHO) and other international organizations indicate that official suicide numbers underestimate the problem due to inaccurate reporting.

Since suicides are still considered to be medico-legal issues, they are underreported due to fear of police, courts and the stigma.

Attempted suicides is another point in the spectrum. Studies in India and outside have shown that for every person who dies by suicide, at least ten to fifteen persons have attempted suicide with or without receiving adequate healthcare. Thus, it is estimated that nearly 1,500,000 – 2,000,000 suicide attempts occur every year in India.

The number of persons with a suicidal behavior or ideation is only a guess as there are no large scale population based studies done in India to quantify the problem. The central question of 'why do people die by suicide or attempt it' is a complex one. The official reports indicate that causes were not known in 15.6 percent of suicides. General and vaguely mentioned causes like family problems, illness, economic factors, dowry deaths do not form the basis for specific and targeted interventions.

Alcoholism, domestic violence, acute crisis situations and mental health conditions such as depression contribute to the list of causes as well. These, coupled with the lack of support from family, friends and society during a crisis situation are also seen to be contributory factors. Over time, research across the world from several organizations has revealed that suicides are due to a complex interaction of social, cultural, economic and health related factors and are often due to risk factors that are present in individual, family or in society.

This complex interaction ultimately drives an individual to a state of helplessness, hopelessness and worthlessness, culminating in suicidal acts.

Despite the ongoing debates on what causes suicide, it has clearly become obvious that suicides are predictable and preventable.

Some major interventions have significantly contributed for suicide reduction. These range from restricting the easy availability of pesticides and drugs, timely and appropriate medical care for persons with attempted suicides, access to health professionals and suicide helplines to early recognition of suicidal behaviors and time management. Early recognition can be facilitated with the help of public awareness programs in educational institutions, workplaces and in communities for stigma reduction and others.

Undoubtedly, better media reporting practices that stress on how individuals can cope in difficult situations has been helpful. With a good mix of suicide prevention policies and programs along with public participation, it is possible to reverse this growing trend of voluntarily ending lives in difficult situations.

Dr G Gururaj is professor and head, department of epidemiology at NIMHANS