In a first, a study has provided nationally representative data on suicidality in India and reveals that for every one person who dies by suicide, there are almost 212 people who have ideated killing themselves, planned for it, or attempted self-harm. Suicidality refers to non-fatal suicidal thoughts and behaviours which include to suicide ideation, plan, intent, preparatory behaviour, and attempt.
The study, called “A population-based analysis of suicidality and its correlates: findings from the National Mental Health Survey of India, 2015–16” was recently published in The Lancet, a medical journal. It has been conducted by a core team from National institute of Mental Health and Neuro Sciences (NIMHANS), investigators from the 12 Indian states selected for the study, and field teams for data collection in each state. The sample size was 34,748 people who completed the interviews.
Findings
It was found that 5.1% of those interviewed had some level of suicidality, with 0.3% having made at least one suicide attempt in the preceding month. The most common phenomenon in suicidality was suicidal ideation – 0.9% of the participants had a plan to take their life. And 0.4% were found to have taken conscious steps towards attempting suicide in the preceding month. 0.3% had made an attempt to kill themselves in the preceding month.
Overall, suicidality was higher among women (6%), than men (4.1%) in all age groups, with highest suicidality being recorded in the 40-49 age group in women. In men, suicidality rate peaked in those aged 60 and above. However, in high levels of suicidality (compared to low and moderate), the difference in rates between men and women was less pronounced.
However, while suicidality was higher in women, men were more likely to die by suicide. “Differences in causes, underreporting, availability and choice of means for suicide, differences in care seeking, availability of care, cultural differences in perceiving suicidality or suicide as a method of coping with stress or conflict, and differences in the gendered social roles between men and women have been proposed as reasons for this paradox,” the study says.
Further, those living in urban metropolitan areas reported higher suicidality than those in urban as well as rural areas.
Other socio-economic factors were also found to increase the risk of suicidality like lower education levels, low income, being widowed, separation, divorce, and unemployment.
Those with depressive disorders and alcohol use disorders also had an increased risk for high suicidality compared to those without these mental health issues.
Need to address suicidality to prevent suicide
The study stresses on the need to understand suicidality as a public health issue and for data on suicidality to serve as a basis for any national strategy to prevent suicide.
“Although not all suicidality ends in death by suicide, the huge morbidity associated with suicidality should not be ignored (while weighing the huge mortality burden of death by suicide), especially in light of promoting wellness through universal health coverage and the National Health Protection Mission in India. Despite suicidality having a substantially higher prevalence than psychotic, affective, and neurotic disorders, suicidality and suicide prevention have often been a low public health priority in India,” the research argues.
It recommends that expansion, coverage and better delivery of mental health services with a strong push towards addressing suicidality is essential, as is resourcing and equipping primary healthcare workers in early recognition of suicidality to prevent death by suicide. “A real-time data surveillance system for suicidality should be implemented to inform suicide prevention strategies,” it adds.