Families, friends and the society can intervene to save lives. How?
In recent years, suicides have risen as a major public health problem contributing to significant number of deaths, hospitalizations 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.
Limited studies reveal that for every one person who dies from a suicide, nearly ten to fifteen more have attempted suicide while a hundred 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 the majority vulnerable to attempt or complete suicidal acts. This places the onus of preventing suicides not only with the medical fraternity and the Government, but also with society. This, provided we are equipped with the skills to identify persons with suicidal thoughts around us. In this series 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 lies amongst us. As per official reports from National Crime Records Bureau, Ministry of Home Affairs, Government of India, 1, 34,799 persons lost their lives in a suicidal act during the year 2013. Suicides have seen a phenomenal increase over time in India from nearly 40000 in 1980 to 135000 by 2013. The national rate of suicides is 11/100000 population per year.
Independent research studies by WHO (World Health Organization) 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 and courts and stigma.
Attempted suicides are another point in the spectrum. Studies in India and outside have shown that for every completed suicide nearly 10-15 persons who have attempt suicide and may or may not receive adequate health care. Thus, it is estimated that nearly 1,500,000 – 2,000,000 attempted suicides occur every year in India.
The number of persons with a suicidal behavior or ideation is anyone’s guess as there are no large scale population based studies in India to quantify the problem. The central question of “why do people attempt suicide” is a complex one. The official reports indicate that causes were not known in 15.6 % 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 at 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 timely management. Early recognition can be facilitated with the help of public awareness programs in educational institutions, work places 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 and 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 Epidemielogy at National Institute of Mental Health & Neuro Sciences (NIMHANS)