No country in the world is free from suicide. As per World Health Organisation (WHO), suicide was the fifteenth leading cause of death in 2014, accounting for 1.4% deaths worldwide. More than 800,000 people die of suicide every year with many more attempting suicide, of which 75% occur in low and middle-income countries. Although suicide occurs throughout the lifespan, it is the second leading cause of death among 15-29 year olds after road traffic accidents.
The highest suicide rate of 44.2 per 100,000 of the population in the world has been recorded in Guyana followed by the Republic of Korea at 36.8 per 100,000 of the population. Saudi Arabia has the lowest reported suicide rate of 0.3 per 100,000 of the population. The South East Asia has the highest suicide rate in the world with a regional average of 17.1 per 100,000 of the population. Sri Lanka has the highest suicide rate of 29.2 per 100,000 of the population while Indonesia has the lowest suicide rate of 3.7 per 100,000 of the population in the region. India has the second highest suicide rate at 20.9 per 100,000 of the population in South East Asia.
There are huge gaps in the reporting and documenting of suicide deaths worldwide especially in low-income countries. It is partly due to stigma, criminalisation, lack of trained manpower and overall poor record keeping. Hence, it is probable that suicide mortality could be much higher than noted in such regions. There are at times political reasons for not documenting some deaths as suicide, for example, the frequent farmer suicides in India. Many countries have already decriminalised suicide and India has also decided to do so with the introduction of the Mental Health Care Bill 2016. Decriminalisation of suicide has helped to reduce the stigma and enabled people to seek help. Globally, there has been 9% decrease in the deaths due to suicide.
In India, 5650 farmers committed suicide in 2014. In the same year, more than 20,000 housewives died of suicide. It is reported that since 1997, more than 20,000 housewives have been committing suicide every year with a peak of 25,092 suicides in 2009. A study published in the Lancet in 2012 found that suicide rate in Indian females aged 15 years and older is more than two and half times greater than it is in same age women in high-income countries. The suicide rate in women is highest in India than any other country in the world.
Depression and anxiety are the most common mental disorders worldwide affecting one in ten or about 700 million people. With better national policies and effective treatments for depression and anxiety, many countries mostly in the high-income zone have been able to prevent and reduce suicide mortality. Moderate and severe depression, both are included in the Mental Health Action plan 2013-2020 of World Health Organisation (WHO) with a target of increasing service coverage to 20%. Suicide prevention is an integral part of the Action Plan with an aim of reducing suicide mortality to 10% by 2020.
For any national response to be effective, suicide prevention strategy needs to be multi-sectorial, holistic and workable within the cultural context. This includes training of manpower, early identification, treatment of common mental disorders especially depression, management of suicidal behaviours, follow-up, and management within the community settings. Restricting access to the means of suicide like pesticides, guns and medications is very important for any strategy to work.
With the introduction of the Mental Health Care Bill 2016 and decriminalisation of suicide in India, it is imperative that there is a national suicide policy targeting the reasons behind the high suicide rate, especially in women. Education, training of manpower, social equality, control over social evils like dowry and forced marriages, treatment of mental health problems especially depression are some of the essential measures which need to be included. Pesticides being the number one means of suicide in India, with free availability even in remote places of the country, need strict regulation to save lives. Finally, it is important to record data effectively and honestly which in turn will help to plan long term policies and prevention strategies.
