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Updated: June 23, 2012 01:05 IST

Invisible health risk that stalks India’s youth

Vikram Patel
Comment (20)   ·   print   ·   T  T  
DYING YOUNG: The burden of suicide is borne disproportionately by the 15-29 age group. Photo: K. K. Mustafah
The Hindu DYING YOUNG: The burden of suicide is borne disproportionately by the 15-29 age group. Photo: K. K. Mustafah

A Lancet study reports that suicide is the second highest cause of death among the young

The medical journal, The Lancet has published a study today which should bring attention to a little known human tragedy which is being played out across our country. The research is based on the first national survey of the causes of death, conducted in 2001-03, by the Registrar General of India. Many people die at home in India, especially in rural areas, and without medical attention. As a result, their deaths, like many in the developing world, have no certifiable cause and are invisible to the public health system and society at large. This landmark effort of the Registrar General to systematically document the causes of death has transformed our understanding of why Indians die.

Higher in the South

The study has reported some startling findings with regards to suicide in India. Suicide rates in India are among the highest reported from any country. Suicide rates are much higher in rural areas, and in the southern states of the country. The fatality rates may be higher in India than in many western countries because the favoured method of suicide is the use of pesticides (in comparison to, say, taking an overdose of sleeping pills). Less surprisingly, the National Crime Records Bureau (NCRB) data, the only routinely collated national data on suicide, under-report between a quarter and a third of all suicides in men and women respectively. But perhaps the most important finding of all is that the burden of suicide falls disproportionately on India’s youth. Nearly 60 per cent of all suicide deaths in Indian women occur between the ages of 15 and 29 years, the corresponding figure for men being 40 per cent. Suicide is the second leading cause of death in young people of both genders and, with the falling trends of maternal mortality, is likely to become the leading cause of death in young women in the near future.

Unless, of course, the country takes action to stem this tragic tide.

The immediate course of action must be to recognise with urgency that suicide is a leading public health concern in India, in particular for young people. Policy actions need to address the causes of suicidal behaviour. The fact is that the high risk of suicidal behaviour in young people is a finding reported from many other countries and is likely to be related to the risk-taking and impulsivity which characterises this phase of life. In a nutshell, one is more likely to react to upsets in life in a risky and impulsive way during one’s youth. But this fact alone is not a sufficient explanation, for there still needs to be something which causes the person to become upset in the first place. While there are no nationally representative studies of the causes of suicide in India, a number of smaller studies, mainly from southern and western India, all point to similar findings of the risk factors which lead an individual to attempt suicide. In essence, social and inter-personal factors such as violence and disappointments in relationships, coexist with mental health factors, notably depression and substance abuse, as the leading determinants of suicidal behaviour.

Surveys

These individual level determinants, however, do not fully explain the dramatic regional variations in suicide in India. The new study findings show that suicide death rates were generally greater in the more developed southern states which have nearly a ten-fold higher suicide rate than some of the less developed northern states. This South-North gradient has also been observed by the NCRB, but has often been discounted as it was believed to be due to a reporting bias, viz., that the cause of death statistics were more reliable in south India. The new study has confirmed that these variations are, in fact, real. Further support for this concentration of the burden of youth suicide in southern India comes from the World Mental Health surveys whose site in Puducherry reported one of the highest rates of self-reported suicidal behaviours in the world. One is forced, then, to ask potentially sensitive questions about what contextual factors may be contributing to this dramatic regional variation. One possibility is that the higher rates of suicide in the more developed and educated communities of India may be attributed to the greater likelihood of disappointments when aspirations that define success and happiness are distorted or unmet by the reality faced by young people in a rapidly changing society where jobs may be higher paying but less secure and where social networking more accessible but loneliness more common. This might be pure conjecture, of course, but I cannot think of any more plausible explanation why a young person in a more developed society of India where health care, education and economic growth are relatively more advanced should be more likely to attempt suicide than a peer in a much less developed society of the country.

Irrespective of these questions, the fact remains that suicide is a leading cause of death of young people in India, killing twice as many people as HIV/AIDS and nearly as many women as maternal causes. However, unlike these two other conditions, suicide attracts little public health attention. Beyond the toll of deaths, we need to acknowledge that completed suicide rates may reflect only the tip of the iceberg; the majority of suicide attempts are not fatal and simply go uncounted. The vast majority of people in this country have no access to any of the evidence based strategies which are well-established to address the risk of suicide, from limiting access to lethal methods such as pesticides, addressing violence experienced by young people, building life skills and promoting mental health in schools and colleges, and improving access to treatment for depression and counselling for those who survive a suicide attempt. But, we must also be honest that the story of suicide in India is likely to be a complex one which needs further inquiry to address the bigger questions about the role of society and, in particular, social change, as a driver of this marker of hopelessness. If, indeed, social change is a driver of youth suicide, then we need to reflect on our model of development for the speed of change is only increasing, and spreading, across the country. In the end, suicide is perhaps the quintessential example of a health outcome in which society plays as crucial an explanatory role as medicine — and it will need a partnership between medicine and society to understand and address its toll.

(Vikram Patel is with the London School of Hygiene and Tropical Medicine, and Sangath, Goa.)

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My observation to the cause of suicidal tendency among youths is due to lack of self-sufficiency. Until a child finishes his or her education or to get a job they depend on their parents' income. All of a sudden they are perplexed and stunned to take their responsibility hence they succumb to suicide. I do believe that parents should play a crucial role to make their children self-sufficient thereby they will enjoy their valuable life.

from:  DIJESH PD
Posted on: Jun 24, 2012 at 07:21 IST

suicide in SOUTH India not by pesticide alone but yellow oleander too are often consumed by the women folk in villages.poverty, associated with depression in addition to social cause genetically predisposed individual often commit suicide,. consanquinance marriage is quite common among Indian population that predispose the genetically two weak parents rearing the same xerox copy of depression prone offspring whose brain deficit in its chemicals of neurotransmittors not able to cope up cognitively but emotionally handling the situation result in high rate of suicide in India. Marriages among the relatives ,among the same caste, among the same religions never yeilds good genes.Population explotion with above weak genes will multyly the depression rate with cosequenses of high suicide rate with changing high stress levels which is not able too cope up by these individuals.

from:  Dr.E.Subbarayan
Posted on: Jun 23, 2012 at 11:34 IST

I am as well not entirely sure of the higher rate of reported suicides in South India. My observation is, there are at least two social classes: a) the financially stable and b) the less stable. I could relate to some of the earlier comments in this page about stress, materialistic ambitions more to the former. The reason I think is, in the south many of us have been brought up in a culture of saving/investment which was natural given our pre-1990's economic status[esp'ly without a government safety net, except for govt pensions]. Regardless of the improved financial conditions, there is reluctance in the society, to move away from material security perhaps partly due to lack of government safety nets. In short, western world is capitalistic with government safety net, while we capitalistic without it. Just my views!

from:  Srini B
Posted on: Jun 22, 2012 at 23:43 IST

One question: Do we need a study -- and that too in Lancet, a British Med Journal -- to conclude that "Many people die at home in India, especially in rural areas, and without medical attention."? It is self-evident to anyone who has any rudimentary understanding of lives of rural folks in India, their lifestyles, and the resources available within on or 2 kilometers of their hamlets in terms of basic healthcare and access to a well-trained doctor. And with the exploitative nature of modern medicine in India, is there any wonder people die in their homes with nobody knowing the causes for their death? Just a few ?. With all the sophisticated advanced medical colleges in India teaching epidemology, public health and geriatric, why nobody was interested in getting the basis statistics on this topic? I am not talking about finding solutions.

from:  Kollengode S Venkataraman
Posted on: Jun 22, 2012 at 23:22 IST

The study is laudable, gives the exact picture of mental state of the nation. Youths are referred to as the future of a nation, the mental health of the future of the nation seems to be weak. The study says that defragmentation of family structure and increasing loneliness among young men and women could be some of the factors. Why the suicide rates of developped countries, which are basically individualistic is lower than that estimated among Indian youth? The problem is because of the unplanned and chaotic goals set by the nation. While we focus more on materialistic 'economic' growth we tend to lose focus on wholesome growth of the nation. Does anyone have ever come across mental health clinic, counselling clinic etc like we have those pizza-points. In what way pizzas will improve one's health? Only one thing can save this nation and the world, give up materialistic and foolish 'economic' growth and build a strong, healthy and wholesome minds.

from:  Richard Smith
Posted on: Jun 22, 2012 at 23:08 IST

As a reader of the Hindu I would like to know more about the existence of the helplines which were established for the people who get depressed and get an idea of suicide attempt!
How far these helplines are being utilised?

from:  teja reddy
Posted on: Jun 22, 2012 at 21:56 IST

the major cause of being incrementation in fatality rates in India is not only disappointments in relationships, coexist with mental health factors, notably depression and substance abuse.among youth many people being infatuated towards the opposite sex simply saying affairs and building up more affection in a crazy way causes effect their death. I am not pointing out to one or criticizing the whole youth,there should be love for survival,every Indian should show love towards each other but in a way that wants nothing at the same time it must cost a great thing.

from:  pavani sahukari
Posted on: Jun 22, 2012 at 21:29 IST

Rural suicides are usually murder-suicides where the despondent or depressed head of the family makes the choice and commits the act. Usually, it happens out of desperation in finance and probable repayment difficulties. Matter of honour is a very important cultural content in the Indian life and that seems to be another trigger for this unfortunate outcome. Suicide in young city people in India seem to be triggered by rejection or unfulfilled romantic liaisons and academic or career downfall. In all these cases early detection and engagement of counsellors become necessary and urgent. Solution oriented counselling and grief counselling may help many while some may need antidepressants and others financial assistance. Engaging the family of a depressed person can keep him/her safe,somewhat.

from:  Saratchandran
Posted on: Jun 22, 2012 at 19:03 IST

I don't think materialism has anything to do with suicides, the most common theme seems to be sexual repression and cultural ethos. More acceptance is needed towards single motherhood and premarital sex. The youth are torn between the fast changing assumptions of life and the way old conservationism. Society should become more liberal and treat the sons and daughters as human beings keeping their basic physiological needs in mind. It is very strange blaming materialism, as a materialist would never want to die as the material world would end as it is. It is the helplessness of an individual to break away from the strangle hold of indian culture and explore a very basic human emotion is causing this trend.

from:  venkata sree charan kuppili
Posted on: Jun 22, 2012 at 18:13 IST

youth have to be energetically active both emotionally as well as physically either in any of the productive, creative or spiritual concerns or in the activities that satisfies peers or anything that they call as 'timepass' that gradually leading to spoiled life and finally leading to a suicide.

from:  Linza James
Posted on: Jun 22, 2012 at 17:49 IST

After birth of a child,the journey of an indivisual starts.Outside home there is already so much of chaose.The indivisual has to face a lot of challenges outside,its a fact.For overcoming the challenges successfully a childs upbringing,the home environment,attitude of parents matters a lot.So, it is the cause of family pressre and chaotic home environment that leads to suicide of an indivisual.When somebody gets failed outside,because of family environment he feels frustrated and takes the step.Humane beings have come to a stage where there is emptiness inside,lack of self believe,low self esteem.But we can change that by acquiring the qualities sympathy and empathy both in work environment as well as home environment.Another main reason for suicide is high expectation from self and others.When somebody can't meet his expectation and parent's expectation he comes to a stage of guilt,frustration and takes the fatal step.So, parents shouldn't expect a lot from there child.

from:  Aishi Sahu
Posted on: Jun 22, 2012 at 16:24 IST

What a lamentable statistical data ! Courage should be inculcated in the minds of the young right from the childhood to face the difficulties in the life as life is certainly an admixture of joys and sorrows.

from:  ravi
Posted on: Jun 22, 2012 at 15:06 IST

A very interesting article indeed, shedding light on a less understood
and neglected aspect .
High rates of suicides among the youth in India can be attributed to
heavy peer pressure whether it be in education or relationships,
enunciation of suicide as a means of emancipation from all troubles in
some films and television serials and lack of a strong emotional
support system viz a viz parents/family.
Students hardly use the services of a Counsellor in a school or
college, if there is one. Seeking help while experiencing tough times
is rarely done and one goes through depression without knowing he/she
is going through it.
Use of media to inform and educate youth against suicide is
important. Dissemination of information about suicide prevention
centres and counselling facilities will help the affected to give a
chance to life.

from:  subhashree narain
Posted on: Jun 22, 2012 at 13:50 IST

We, the so called youths, are living in a society which is changing
rapidly and this change is more materialistic rather than spriritual.
We are forced to conduct ourselves in the manner that our parents want
and its not that they are wrong, they are doing what society is
demanding. Our country's economic instability, inflation causes jobs
insecurity which leads to mental setback and this feeling is higher in
students who are more meritorious. Thats why children of South Indian
who are so much culturally rooted, educated and developed are more
likely to suceed as well as fail leading to drastic emotional change
from second to second and so they take such actions!!!

from:  Apoorv Utsav
Posted on: Jun 22, 2012 at 12:49 IST

We have very good directors in the South, they should make filim on the effects of suicide amongst the youth in this country. A person who goes to the extent of committing suicide should think that he could use his life in more useful way by serving this society, there are umpteen no of vouluntary organisations which look for volunteers to serve the society. for eg, Krishnan from Madurai who feeds daily the beggars of Madurai. or the Amar seva Sangam in Tirunelveli, and so on....

from:  Ananth
Posted on: Jun 22, 2012 at 12:44 IST

TH has given its opinon which is laudable. I would, however, like to add mention one more factor that is mostly responsible for suicides and other types of depressions, particularly amongst youth. Earlier our parents and grand parents used to tell us the stories related to patriotism, spirituality and good conduct. Now present parents inject the seeds of competition, higher achievements, rich man's culture and envy etc in their kids. They raise their desire level so high that they feel depressed once they fail to reach that level.

from:  J.AKSHOBHYA
Posted on: Jun 22, 2012 at 12:29 IST


All of our society has to be blamed for tremendous increase in suicide
rate. Often suicides are glorified as matrydomes by political parties
and social groups. Student suicides in self financing colleges are
often taken up by students organization. these are leading to more and
more of suicides. Same is the case of farmer suicide. It is a wrong intention, what we should do is the find the route course and find
solution to that. Media should be cautious in reporting these
incidents.There should not be excessive descriptions or notes that may
support suicide. Collective efforts can certainly bring about changes.

from:  Reema George
Posted on: Jun 22, 2012 at 10:32 IST

There is drastic change in the core family structure and behavior in the most literate state
of Kerala.The old Tharavadu with a Karanavan(Head of family) has paved way for nuclear
families with one/ two children and parents employed.Family meets on weekends and
communication restricted through mobiles.There is craze for materialism and
possession.Comparison for possession is made with affluent relatives and
colleagues.Frustration sets in.High targets are made and once failed lead to frustration and
accumulated to depression.On back home there are none to hear and people are there to
talk only leaving to loneliness -the worst state of human mindset-.Divorce rate is
alarming.Once becoming an earning member and pampered by parents the girls assume
extra independent and husband becomes disposable.Sadistic hehaviour is on the
rise.Clinical psychologists suggest parental neglect,genetic hysteric behavior and above all
sense of deprivation lead to suicidal behavior.Social research is needed.2

from:  Dr K V Peter
Posted on: Jun 22, 2012 at 10:06 IST

The main reason of this is mostly our negligence.

from:  Inturi Manasa
Posted on: Jun 22, 2012 at 08:46 IST

As a regular reader of thehindu.com, I would like to say a big thankyou for this very interesting article.
But I want more, please! - more information, that is.
As a quick example:
1. The second highest cause of death amongst the young is suicide? Why pick on the second? What is the first? What is the third, and so on.
2. What exactly is the age group defined as "young"?
3. Could we have the death-rate statistics in a table please, showing ranked cause, demographic distribution, etc.? More data, please!
4. What are "maternal" causes for death amongst young women? Is this a euphemism for deaths resulting from limited or no access to decent pre- and post-maternal healthcare - or what?
5. Where are the links to the Lancet article so that I may read it online for myself?

More, please!

from:  Slartibartfarst
Posted on: Jun 22, 2012 at 05:23 IST
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